Hip fractures are the most common cause for admission to an acute orthopaedic ward in the UK, and typically affect elderly, frail individuals with extensive co-morbidity. As such, they are associated with a high burden of morbidity and mortality as well as significant financial cost. Standards have therefore been developed to improve care and outcomes for hip fracture patients, including through the introduction of the ‘best practice tariff’ payment system in English hospitals. These emphasize a multidisciplinary team approach with early involvement of appropriately trained healthcare professionals including anaesthetists, orthopaedic surgeons and orthogeriatricians. Key elements of the perioperative optimization of patients following admission with a hip fracture include prompt and effective analgesia, including the use of regional nerve blockade, the rapid identification and correction of acute medical problems, particularly cardiac arrhythmias, electrolyte abnormalities and anaemia, and careful management of fluid balance. In addition, medication review is of critical importance, particularly with respect to antiplatelet agents and anticoagulants. In all cases, early surgery, ideally within 36 hours of admission, should be considered a key aim given evidence supporting a reduction in complication and mortality rates when this is achieved. Similarly, patients should be mobilized as soon as possible in the postoperative period in order to maximize their rehabilitation potential.